Outcomes following trauma laparotomy for hypotensive trauma patients: A UK military and civilian perspective.

Autor:	Marsden M; From the Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, United Kingdom (M.M., L.N., I.M.S., J.G.P.-B., N.R.M.T., D.M.B.); Centre For Trauma Sciences, Blizard Institute, Queen Mary, University of London, London, United Kingdom (M.M., R.C., K.B., N.R.M.T.); Academic Department of Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, United Kingdom (R.C.); Northwick Park and St Marks Hospitals, London, United Kingdom (L.N.); 205 Scottish Field Hospital, Glasgow, Scotland (I.M.S.); Institute of Naval Medicine, Gosport, Hampshire, United Kingdom (J.G.P.-B.); and Department of Medical Statistics, Leicester University, Leicester, United Kingdom (L.M.K.)., Carden R, Navaratne L, Smith IM, Penn-Barwell JG, Kraven LM, Brohi K, Tai NRM, Bowley DM
Jazyk:	angličtina
Zdroj:	The journal of trauma and acute care surgery [J Trauma Acute Care Surg] 2018 Sep; Vol. 85 (3), pp. 620-625.
DOI:	10.1097/TA.0000000000001988
Abstrakt:	Background: The management of trauma patients has changed radically in the last decade, and studies have shown overall improvements in survival. However, reduction in mortality for the many may obscure a lack of progress in some high-risk patients. We sought to examine the outcomes for hypotensive patients requiring laparotomy in UK military and civilian cohorts. Methods: We undertook a review of two prospectively maintained trauma databases: the UK Joint Theatre Trauma Registry for the military cohort (February 4, 2003, to September 21, 2014) and the trauma registry of the Royal London Hospital major trauma center (January 1, 2012, to January 1, 2017) for civilian patients. Adults undergoing trauma laparotomy within 90 minutes of arrival at the emergency department (ED) were included. Results: Hypotension was present on arrival at the ED in 155 (20.4%) of 761 military patients. Mortality was higher in hypotensive casualties (25.8% vs. 9.7% in normotensive casualties; p < 0.001). Hypotension was present on arrival at the ED in 63 (35.7%) of 176 civilian patients. Mortality was higher in hypotensive patients (47.6% vs. 12.4% in normotensive patients; p < 0.001). In both cohorts of hypotensive patients, neither the average injury severity, the prehospital time, the ED arrival systolic blood pressure, nor mortality rate changed significantly during the study period. Conclusions: Despite improvements in survival after trauma for patients overall, the mortality for patients undergoing laparotomy who arrive at the ED with hypotension has not changed and appears stubbornly resistant to all efforts. Specific enquiry and research should continue to be directed at this high-risk group of patients. Level of Evidence: Prognostic/Epidemiologic, level IV.
Databáze:	MEDLINE
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